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• <br /> • <br /> [typed name of affiant] <br /> [address of affiant, line 1] <br /> 5uptails,.. eN <br /> • [address of affiant, line 2] <br /> State of Florida, County of Mtat ODE • <br /> Sworn to (or affirmed) and subscribed before me this I9"° day of <br /> JuMj (month), -ot3 (year), by <br /> STVV}CQ • SSo (name of person making statement). <br /> • e x••,1.11■ '■ <br /> ' . <br /> (Signature of Notary " bli, - Stat- of Florida) • <br /> (Print, Type, or Stamp Commissioned Name of Notary Public) <br /> Personally Known ✓ OR Produced Identification • <br /> Type of Identification Produced 11-14 <br /> -/ '`,µY Pi4,� MAURICIO 8ETANCUR • <br /> ( i° _1 `�? Notary.Public-State of Florida ;. <br /> sN. ' My Comm.Expires May 4,2017 • <br /> .�, ■7: °,• Commission#EE.879454 r <br /> " Bonded Through National Notary Assn. 0 <br /> 2 <br /> • <br />